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Bronchial response to nebulized antibiotics in children with cystic fibrosis
H L Chua1, G G Collis, P N Le Souëf
1Dept of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Western Australia.
Insights
Nebulized antibiotics can impact lung function in children with cystic fibrosis. Hypertonic solutions like ticarcillin caused significant bronchoconstriction, affecting forced expiratory volume in one second (FEV1).
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Respiratory Medicine
Background:
- Increasing use of nebulized antibiotics for cystic fibrosis (CF) patients.
- Need to understand the impact of solution tonicity on lung function in pediatric CF.
- Previous research has not fully elucidated the effects of varying tonicity.
Purpose of the Study:
- To assess the effect of nebulized antibiotic solutions with different tonicities on lung function in children with CF.
- To compare the impact of normal saline, tobramycin, and ticarcillin on forced expiratory volume in one second (FEV1).
- To determine if hypertonicity influences lung function outcomes.
Main Methods:
- 12 children (aged 5-15) with CF participated.
- Randomized crossover design with nebulized normal saline, tobramycin, and ticarcillin.
- Forced expiratory volume in one second (FEV1) measured at baseline and 5, 15, 30 minutes post-nebulization.
Main Results:
- Ticarcillin (3,080 mosmol.kg-1) caused a significant fall in FEV1 (10.7%) compared to normal saline (4.8%, p<0.05).
- Ticarcillin's FEV1 reduction was significantly greater than tobramycin's (1.2%, p<0.05).
- Bronchoconstriction from ticarcillin persisted for 30 minutes.
Conclusions:
- Nebulized hypertonic antibiotic solutions can negatively affect lung function in pediatric CF patients.
- Tonicity is a critical factor in the safety and efficacy of nebulized antibiotics.
- Careful consideration of solution osmolality is necessary when administering nebulized antibiotics to children with CF.
Abstract:
Nebulized antibiotics are being used increasingly in children with cystic fibrosis. We assessed the effect of nebulized antibiotic solutions of varying tonicity on lung function in 12 children aged 5-15 yrs with cystic fibrosis. Baseline forced expiratory volume in one second and (FEV1) was measured, followed by a single nebulization of normal saline (272 mosmol.kg-1), tobramycin (248 mosmol.kg-1), or ticarcillin (3,080 mosmol.kg-1). All children received each of these, administered randomly, one per day. FEV1 was remeasured 5, 15 and 30 min after completion of the nebulization. Ticarcillin (mean fall 10.7% (SD 8.9)) caused a larger fall in FEV1 than normal saline (4.8% (4.3), p less than 0.05). The fall in FEV1 for ticarcillin was greater than for tobramycin (1.2% (2.0), p less than 0.05). Normal saline did not result in a significantly larger fall in FEV1 than tobramycin (p greater than 0.05). Bronchoconstriction to ticarcillin persisted at 30 min. We conclude that nebulized antibiotics can affect lung function in children with cystic fibrosis if the solutions are hypertonic.